21 - Nipple–Areola Complex Reconstruction

Abstract

Nipple–areola complex (NAC) reconstruction can be an important part of breast reconstruction and add an aesthetic component to breast reconstruction. Although several techniques for NAC reconstruction have been described in the literature, only two methods are commonly used by most plastic surgeons and have frequently been studied. One is the skate flap in which the nipple is reconstructed by a local flap like a skate and the areola circle is reconstructed with a full-thickness skin graft. Another is the C-V flap. It is devised as a modification of the skate flap to reduce the need for skin grafting the areola. It is a random “flap-on-a-flap,” where the “C” portion of the flap derives its blood supply from the “V” flap. The areolar circle after a C-V flap reconstruction can be tattooed later. Each type of NAC reconstruction may be equally good based on the patient's selection and the surgeon's experience and preference. In this chapter, the skate flap with a skin graft and the C-V flap, two most commonly performed NAC reconstructions, are described. The authors have also added their modifications to each type of NAC reconstruction so that a better reconstructive outcome can be achieved. Each technique will be described in details and several refinements are also described.